Massage Intake Form

Member Information

Member Name *

Current conditions or concerns *

Muscle tightness Chronic pain Recent injury Post-surgery recovery Pregnancy Stress / tension None

Any medical conditions we should know about? *

Yes No

What type of session are you looking for? *

Areas to focus on *

Neck Shoulders Upper back Lower back Hips / glutes Legs Arms Full body

Areas to avoid

Neck Shoulders Upper back Lower back Hips / glutes Legs Arms None

Preferred pressure *

Session style preference *

I understand this session is for wellness purposes and I will communicate any discomfort, pain, or concerns during the session. *

Digital Signature (use finger or mouse to sign) *